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Nursing Management Nursing management focuses on teaching about disease management, teaching about nutritional management, teaching about medication therapy, and promoting family and child coping.o Cyclosporine or tacrolimus: used occasionally in conjunction with 6-MP or azathioprine to maintain remission in fulminant ulcerative colitis o Methotrexate: sometimes used to manage severe Crohn disease o Anti-tumor necrosis antibody therapy: widely used for children with Crohn disease; occasionally used for children with ulcerative colitis Promoting Family and Child Coping Inflammatory bowel disease is a chronic and often debilitating illness.Provide information about the following common medications used to control the disease: o 5-Aminosalicylates (5-ASA): used to prevent relapse (usually used in ulcerative colitis) o Antibiotics (usually metronidazole and ciprofloxacin): typically used in children who have perianal Crohn disease o Immunomodulators (usually 6-mercaptopurine [6-MP] or azathioprine): used to help maintain remission.When the disease is active, lactose may be tolerated poorly, and vitamin and iron supplements will most likely be recommended.Children tend to be of small stature due to the illness itself and steroid use, which stunts growth; this may cause psychological issues, especially for older boys (Haas-Beckert & Heyman, 2010).Explain that in severe cases enteral feeding tubes or TPN may be needed; this is rare but often induces remission.For example, adequate nutrition with a high-protein and high-carbohydrate diet may be recommended.

Nursing Management Nursing management focuses on teaching about disease management, teaching about nutritional management, teaching about medication therapy, and promoting family and child coping.
Teaching About Disease Management The diagnosis of Crohn disease or ulcerative colitis can be very difficult for the child and family to comprehend. Provide teaching about the disease process and medication therapy to help the child and family understand the seriousness of the disease. The physician may discuss surgical options during uncontrolled flare-ups, but the nurse may be the person to whom the family members or child address their questions regarding surgery. Provide the family with information to help answer some of their questions and allay fears.
Teaching About Nutritional Management Teach the child and family about nutritional management of the disease. For example, adequate nutrition with a high-protein and high-carbohydrate diet may be recommended. When the disease is active, lactose may be tolerated poorly, and vitamin and iron supplements will most likely be recommended. Explain that in severe cases enteral feeding tubes or TPN may be needed; this is rare but often induces remission.
Teaching About Medication Therapy Medications are extremely important in controlling inflammatory bowel disease. Provide information about the following common medications used to control the disease:
• 5-Aminosalicylates (5-ASA): used to prevent relapse (usually used in ulcerative colitis) • Antibiotics (usually metronidazole and ciprofloxacin): typically used in children who have perianal Crohn disease • Immunomodulators (usually 6-mercaptopurine [6-MP] or azathioprine): used to help maintain remission. Monitor children for neutropenia and hepatotoxicity.
• Cyclosporine or tacrolimus: used occasionally in conjunction with 6-MP or azathioprine to maintain remission in fulminant ulcerative colitis • Methotrexate: sometimes used to manage severe Crohn disease • Anti–tumor necrosis antibody therapy: widely used for children with Crohn disease; occasionally used for children with ulcerative colitis Promoting Family and Child Coping Inflammatory bowel disease is a chronic and often debilitating illness. Many children with this diagnosis can lead normal lives, but frequent illnesses can cause school absences, which in turn add stress to the situation. Because schools have become much less tolerant of absences and tardiness, it may be necessary to write letters to the school explaining the frequent absences or in-school needs. Bathroom privileges should be very flexible for children during flare-ups. Children tend to be of small stature due to the illness itself and steroid use, which stunts growth; this may cause psychological issues, especially for older boys (Haas-Beckert & Heyman, 2010). Children with ostomies as a result of surgical resection may have self-esteem issues related to the presence and care of the ostomy. Arrange for counseling for both the child and family to discuss fears and anxiety related to a chronic disease.